TREATMENT SELECTION GUIDE
(Updated July 2018 for the USMA Class of 1958)
You have been diagnosed with prostate cancer. The first thing you need to do is
to get educated on what this disease is all about and what you can do about it
so you are better able to play a proactive role in the selection and conduct of
your treatment. The "Bible" on the subject is Dr. Patrick Walsh's
"Guide to Surviving Prostate Cancer" (5/18). It's out in paperback.
Get a copy and read all about it so you can ask all the right questions and
make the best decisions.
There are also many excellent web sites out there covering various aspects. Here
are a few good ones to get you started:
spouse/significant other involved in the process right from the start. Her
stake in the outcome is as every bit important as yours, though her priorities
may differ. Take her with you to your consultations with your doctors. You will
be under a lot of stress. She will hear things you miss and will think of
questions that you forget to ask. Coach her in advance as to how she can help.
Get the details of your diagnosis from your urologist to include location and
Gleason score for each positive biopsy sample, and get a diagram. The details
are critical in determining which treatment options are open to you – the more
advanced the cancer, the fewer the options. If for any reason you have doubts
regarding the accuracy of the results or your doctor's interpretation of them, or
if you think he may not have used the most up-to-date diagnostic tools, get a
second opinion. If your urologist doesn't explain all the current treatments
available and all their pros and cons, get a new urologist.
Each treatment option comes with a likely set of short and long term side
effects and risks involving such things as incontinence and impotency, and with
information on containment or spread, likelihood of recurrence, quality of life
as you define it, and even long term survivability. Reliable data on
survivability for a given treatment is a moving target. It takes upwards of
5-10 years to develop even as procedures and techniques continue to improve
over time, making choices all the more difficult.
Given the uncertainties and variable results associated with different
treatments, you need to establish up front just what your priorities are for
treatment outcomes. And your spouse/significant other needs to be an integral
part of the process. For example, she is more likely to be concerned with your
health and survivability than your ability to perform sexually. Work through
this together. You're a team.
When considering treatment options, consult with the specialists in their
respective fields to gain first-hand knowledge to help you make your decision
and best achieve your priorities. Bear in mind, however, that each specialist
tends to favor his/her particular procedure and is likely to recommend it as
your best course of action. So ask a lot of questions, keep an open mind, and
maintain a healthy level of skepticism.
Along with the diagnosed level of your cancer's aggressiveness, be sure to take
into consideration your age and overall state of health. If you are diagnosed
with early stage cancer, your health is poor and you stand a good chance of
dying from something other than the cancer, or you prefer to avoid more
invasive treatments with incumbent side effects, you may want to consider
watchful waiting/active surveillance involving more frequent PSA monitoring and
substantial lifestyle changes to control the cancer's development. Subsequent
treatment is available should the cancer progress.
To assist you in making a treatment choice you will be provided a copy of the
class Treatment Selection Table which gives you the contact information,
diagnoses and treatments selected by those classmates who have already been
diagnosed with and treated for PC and have volunteered to assist newly
diagnosed classmates on a one-on- one basis. Please keep this information
confidential with regard to anyone not listed on the table. Also keep in mind
that their circumstances and priorities for selecting a particular set of
treatments may differ from yours. They will be happy to advise and
assist, but should not attempt to impose their choices on you.
It may also be helpful for you to consult with any physicians you know, regardless
of their specialty, and ask them what course of action they would take were
they to be given a similar diagnosis. Their professional training and
background will enable them to give you impartial, well-reasoned
recommendations, but bear in mind that the questions you pose are hypothetical
and when confronted with a real diagnosis, their actual choices may differ.
Once you have decided on a particular treatment or combination of treatments,
insure that the specialist you select to perform each procedure has extensive
experience in performing it, has an excellent success rate and has a reputation
to match, i.e. he performs many of them on a routine basis and is well regarded
in the medical community. You do not need to participate in the
development of anyone's learning curve. Check out his/her background –
education and training, where he has practiced, years of experience, particular
subspecialty. What do other professionals and prior patients have to say?
Is he well equipped to deal with any preexisting health issues you might have
or surprises he might encounter during the procedure? How much time and
individual attention does he give you? What sort of vibes do you and your
spouse get from the encounters? Are you comfortable with and confident in this
procedure comes with its own set of recovery problems, short and long term.
Query the specialists in detail on these and do your own independent research.
Don't become one of those "What the doctor didn't tell me." patients.
To assist in asking all the right questions, The Prostate Cancer Foundation
offers to email you a .pdf copy of “Questions to Ask Your Doctor” at <https://www.pcf.org/guide/questions-to-ask-your-doctor/>.
You will also be provided with a copy of our
Prostate Cancer History Form for your personal use in maintaining a record of
your diagnosis, treatment priorities, treatment selections and their progress.
If in due course you decide to add your information to the Treatment Selection
Table and make yourself available to assist other classmates, you can use this
form as a basis for one-on-one consultations.
Finally, bear in mind that your diagnosis is a red flag that your lifestyle up
to this point, together with the genes you inherited from your parents has not
afforded you the protection necessary to avoid contracting the cancer, given
whatever circumstances that may have led to the diagnosis. Although you had no
control over your genetic inheritance, you can change your lifestyle. So the
appropriate response to this diagnosis is not guilt, anger or self-recrimination,
but rather a firm commitment to make those lifestyle changes necessary to
control and even defeat this cancer. To assist you in doing so, please refer to
our Prostate Cancer Prevention and Control Guide on our web site at <http://www.west-point.org/class/usma1958-pc/pcprevgd/index.html>.
Print out a copy and give it to your spouse/significant other to beat you on
and about the head with when you don’t follow it. You are now solidly in the
control phase. Also, get your hands on a copy of Dean Ornish's book "The
Spectrum." As discussed in the guide, it is an excellent complement to it.
Another is the American Cancer Society's "Complete Guide to Nutrition for